Registry details
Type
Individual
Primary specialty
Nurse Practitioner, Family
Enumerated
Jun 3, 2016
License(s)
26NJ01122000 (NJ), 26NR11163700 (NJ), 26NJ01122000 (NJ)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 1314 PARK AVE STE 1 | Plainfield, NJ 07060-3253 | 908-561-9733 |
| MAILING | PO BOX 95000, LB#7550 | Philadelphia, PA 19195-7550 | 844-362-1735 |
Watch this provider
Get a webhook/email the day this provider is added to the OIG-LEIE exclusion list or appears in an FDA enforcement action.